KENISHA SHAWNTA PEMBERTON M.D.
NPI 1114289907
Family Medicine in Fort Leonard Wood, MO

Q: What is Kenisha Pemberton's NPI number?

The NPI number for Kenisha Pemberton is 1114289907. It was assigned to this individual provider in the NPPES registry on June 8, 2012.

Q: What is Kenisha Pemberton's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Kenisha Pemberton was last updated on June 14, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 08, 2012PECOS Enrolled

4430 MISSOURI AVE, FORT LEONARD WOOD, MO 65473(573) 596-0417 Get Directions Write a Review

NPPES record last updated: June 14, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Kenisha Shawnta Pemberton M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENISHA SHAWNTA PEMBERTON M.D. (NPI 1114289907) is an individual family medicine provider in Fort Leonard Wood, Missouri, licensed in Florida (ME117245) and active in the NPI registry since June 2012. She is enrolled in Medicare PECOS and maintains a secondary practice location in Sarasota.

NPPES Registry Identity

NPI1114289907

Entity TypeIndividualFemale

Primary Taxonomy207Q00000X

Provider Legal NameKENISHA SHAWNTA PEMBERTONCredential: M.D.

Location Address4430 MISSOURI AVEFort Leonard Wood, MO 65473-9098

Mailing AddressAttn: Mcxp-dqs-cr, 4430 Missouri Avenue, Box 1267Fort Leonard Wood, MO 65473 · (573) 596-0417

Phone(573) 596-0417

Sole ProprietorNo

Enumeration DateJune 8, 2012

Last NPPES UpdateJune 14, 2022

NPPES CertifiedJune 8, 2022

✔ NPI 1114289907 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in FL · ME117245

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

4430 MISSOURI AVE, Fort Leonard Wood, MO 65473

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Secondary Practice Location 1

Location 1237 Payne Pkwy Unit 101Sarasota, FL 34237-7018 · Phone (941) 893-2556

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kenisha Shawnta Pemberton M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Kenisha Pemberton reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Halifax Healthcare Systems Inc

869 mi

Family Medicine

303 N CLYDE MORRIS BLVD
Daytona Beach, FL 32114

Reassigned Medicare billing, Florida enrollment
786 clinicians in this Medicare group

NPI 1245283530 (386) 254-4000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 65473 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$81.64 typical visit price

range $52.28 – $161.24

Typical copayment $20.41 (range $13.07 – $40.31)

Most-billed visit code 99203

Established Patient

$93.24 typical visit price

range $16.30 – $131.05

Typical copayment $23.31 (range $4.07 – $32.76)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. JON-MARC THIBODEAU PA-C

Physician Assistant